title: Benefits and risks of additional ablation of complex fractionated atrial electrograms for patients with atrial fibrillation: a systematic review and meta-analysis.
abstract: BACKGROUND
  The benefits and risks of additional complex fractionated atrial electrograms (CFAE) ablation in patients with atrial fibrillation (AF) remain unclear.
  
  
  METHODS
  Trials were identified in PubMed, Embase, Web of Science, and Cochrane Database, reviews, and reference lists of relevant papers. The primary end point was the recurrence of atrial arrhythmias after a single ablation.
  
  
  RESULTS
  We meta-analyzed 11 studies (total, n=983) using random-effects model to compare PVI (n=478) with PVI plus CFAE ablation (PVI+CFAE) (n=505). Additional CFAE ablation reduced recurrence of atrial tachyarrhythmia after a single procedure (pooled RR 0.73; 95% CI 0.61, 0.88; P=0.0007) at ≥ 3-month follow-up. There was no evidence of heterogeneity among studies (I(2)=33%). Subgroup analysis demonstrated that additional CFAE ablation reduced rates of recurrence in nonparoxysmal AF (RR 0.68; 95% CI 0.47, 0.99; P=0.05), whereas had no effect on patients with paroxysmal AF (RR 0.79; 95% CI 0.59, 1.06; P=0.12). Eight studies reported results of post-procedure ATs. The addition of CFAE ablation increased the rate of post-procedure ATs (RR 1.77; 95% CI 1.02, 3.07; P=0.04). Additional CFAE ablation significantly increased mean procedural times (245.4+75.7 vs. 189.5+62.3 min, P<0.001), mean fluoroscopy (72.1+25.6 vs. 59.5+19.3 min, P<0.001), and mean RF energy application times (75.3+38.6 vs. 53.2+27.5 min, P<0.001).
  
  
  CONCLUSIONS
  The adjunctive CFAE ablation could provide additional benefit in terms of reducing recurrence of atrial tachyarrhythmia for patients with nonparoxysmal AF but not for patients with paroxysmal AF after a single procedure with or without antiarrhythmic drugs (AADs). The main risk of adjunctive CFAE ablation is the increasing rate of untraceable postablation ATs.
authors.affiliation: Department of Cardiology, Shanghai Chest Hospital affiliated to Shanghai Jiaotong University, China.
authors.forename: Shao-Hui
authors.initials: SH
authors.lastname: Wu
authors.forename: Wei-Feng
authors.initials: WF
authors.lastname: Jiang
authors.forename: Jun
authors.initials: J
authors.lastname: Gu
authors.forename: Liang
authors.initials: L
authors.lastname: Zhao
authors.forename: Yuan-Long
authors.initials: YL
authors.lastname: Wang
authors.forename: Yu-Gang
authors.initials: YG
authors.lastname: Liu
authors.forename: Li
authors.initials: L
authors.lastname: Zhou
authors.forename: Jia-Ning
authors.initials: JN
authors.lastname: Gu
authors.forename: Kai
authors.initials: K
authors.lastname: Xu
authors.forename: Xu
authors.initials: X
authors.lastname: Liu
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac / Q000009:adverse effects / Q000379:methods*; D006325:Heart Atria / Q000503:physiopathology*; D006801:Humans; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D018570:Risk Assessment; D016896:Treatment Outcome
keywords: AADs; AF; ATs; Antiarrhythmic drugs; Atrial fibrillation; CFAE; Catheter ablation; Complex fractionated atrial electrograms; DF; Dominant frequency; LA; Left atria; Meta-analysis; Organized atrial tachyarrhythmias; PVI; Pulmonary vein isolation; RCT; RF; Radiofrequency; Randomized controlled trials